Data Format Standardization and DICOM Integration for Hyperpolarized 13C MRI.

Hyperpolarized (HP) 13C MRI has shown promise as a valuable modality for in vivo measurements of metabolism and is currently in human trials at 15 research sites worldwide. With this growth, it is important to adopt standardized data storage practices as it will allow sites to meaningfully compare data. In this paper, we (1) describe data that we believe should be stored and (2) demonstrate pipelines and methods that utilize the Digital Imaging and Communications in Medicine (DICOM) standard. This includes proposing a set of minimum set of information that is specific to HP 13C MRI studies. We then show where the majority of these can be fit into existing DICOM attributes, primarily via the "Contrast/Bolus" module. We also demonstrate pipelines for utilizing DICOM for HP 13C MRI. DICOM is the most common standard for clinical medical image storage and provides the flexibility to accommodate the unique aspects of HP 13C MRI, including the HP agent information but also spectroscopic and metabolite dimensions. The pipelines shown include creating DICOM objects for studies on human and animal imaging systems with various pulse sequences. We also show a python-based method to efficiently modify DICOM objects to incorporate the unique HP 13C MRI information that is not captured by existing pipelines. Moreover, we propose best practices for HP 13C MRI data storage that will support future multi-site trials, research studies, and technical developments of this imaging technique.

Data Format Standardization and DICOM Integration for Hyperpolarized 13C MRI.

Hyperpolarized (HP) 13C MRI has shown promise as a valuable modality for in vivo measurements of metabolism and is currently in human trials at 15 research sites worldwide. With this growth it is important to adopt standardized data storage practices as it will allow sites to meaningfully compare data. In this paper we (1) describe data that we believe should be stored and (2) demonstrate pipelines and methods that utilize the Digital Imaging and Communications in Medicine (DICOM) standard. This includes proposing a set of minimum set of information that is specific to HP 13C MRI studies. We then show where the majority of these can be fit into existing DICOM Attributes, primarily via the "Contrast/Bolus" module. We also demonstrate pipelines for utilizing DICOM for HP 13C MRI. DICOM is the most common standard for clinical medical image storage and provides the flexibility to accommodate the unique aspects of HP 13C MRI, including the HP agent information but also spectroscopic and metabolite dimensions. The pipelines shown include creating DICOM objects for studies on human and animal imaging systems with various pulse sequences. We also show a python-based method to efficiently modify DICOM objects to incorporate the unique HP 13C MRI information that is not captured by existing pipelines. Moreover, we propose best practices for HP 13C MRI data storage that will support future multi-site trials, research studies and technical developments of this imaging technique.

Enzymatic Crosslinked Hydrogels of Gelatin and Poly (Vinyl Alcohol) Loaded with Probiotic Bacteria as Oral Delivery System.

Probiotic bacteria are widely used to prepare pharmaceutical products and functional foods because they promote and sustain health. Nonetheless, probiotic viability is prone to decrease under gastrointestinal conditions. In this investigation, Lactiplantibacillus plantarum spp. CM-CNRG TB98 was entrapped in a gelatin−poly (vinyl alcohol) (Gel−PVA) hydrogel which was prepared by a "green" route using microbial transglutaminase (mTGase), which acts as a crosslinking agent. The hydrogel was fully characterized and its ability to entrap and protect L. plantarum from the lyophilization process and under simulated gastric and intestine conditions was explored. The Gel−PVA hydrogel showed a high probiotic loading efficiency (>90%) and survivability from the lyophilization process (91%) of the total bacteria entrapped. Under gastric conditions, no disintegration of the hydrogel was observed, keeping L. plantarum protected with a survival rate of >94%. While in the intestinal fluid the hydrogel is completely dissolved, helping to release probiotics. A Gel−PVA hydrogel is suitable for a probiotic oral administration system due to its physicochemical properties, lack of cytotoxicity, and the protection it offers L. plantarum under gastric conditions.

A biological condition gradient for coral reefs in the US Caribbean Territories: Part I. Coral narrative rules.

As coral reef condition and sustainability continue to decline worldwide, losses of critical habitat and their ecosystem services have generated an urgency to understand and communicate reef response to management actions, environmental contamination, and natural disasters. Increasingly, coral reef protection and restoration programs emphasize the need for robust assessment tools for protecting high-quality waters and establishing conservation goals. Of equal importance is the need to communicate assessment results to stakeholders, beneficiaries, and the public so that environmental consequences of decisions are understood. The Biological Condition (BCG) model provides a structure to evaluate the condition of a coral reef in increments of change along a gradient of human disturbance. Communication of incremental change, regardless of direction, is important for decision makers and the public to better understand what is gained or lost depending on what actions are taken. We developed a narrative (qualitative) Biological Condition Gradient (BCG) from the consensus of a diverse expert panel to provide a framework for coral reefs in US Caribbean Territories. The model uses narrative descriptions of biological attributes for benthic organisms to evaluate reefs relative to undisturbed or minimally disturbed conditions. Using expert elicitation, narrative decision rules were proposed and deliberated to discriminate among six levels of change along a gradient of increasing anthropogenic stress. Narrative rules for each of the BCG levels are presented to facilitate the evaluation of benthic communities in coral reefs and provide specific narrative features to detect changes in coral reef condition and biological integrity. The BCG model can be used in the absence of numeric, or quantitative metrics, to evaluate actions that may encroach on coral reef ecosystems, manage endangered species habitat, and develop and implement management plans for marine protected areas, watersheds, and coastal zones. The narrative BCG model is a defensible model and communication tool that translates scientific results so the nontechnical person can understand and support both regulatory and non-regulatory water quality and natural resource programs.

Green Metallic Nanoparticles for Cancer Therapy: Evaluation Models and Cancer Applications.

Metal-based nanoparticles are widely used to deliver bioactive molecules and drugs to improve cancer therapy. Several research works have highlighted the synthesis of gold and silver nanoparticles by green chemistry, using biological entities to minimize the use of solvents and control their physicochemical and biological properties. Recent advances in evaluating the anticancer effect of green biogenic Au and Ag nanoparticles are mainly focused on the use of conventional 2D cell culture and in vivo murine models that allow determination of the half-maximal inhibitory concentration, a critical parameter to move forward clinical trials. However, the interaction between nanoparticles and the tumor microenvironment is not yet fully understood. Therefore, it is necessary to develop more human-like evaluation models or to improve the existing ones for a better understanding of the molecular bases of cancer. This review provides recent advances in biosynthesized Au and Ag nanoparticles for seven of the most common and relevant cancers and their biological assessment. In addition, it provides a general idea of the in silico, in vitro, ex vivo, and in vivo models used for the anticancer evaluation of green biogenic metal-based nanoparticles.

Centro de Histoterapia Placentaria "Dr. Carlos Manuel Miyares Cao", 35 años de entrega a la Ciencia Cubana / "Dr. Carlos Miyares Cao" Placental Histotherapy Center, 35 years of dedication to Cuban Science

Introducción: La fundación del Centro de Histoterapia Placentaria, el 25 de abril de 1986, como resultado de la repercusión internacional por el nuevo método cubano del tratamiento del vitiligo con un medicamento obtenido de la placenta humana, descubierto por el doctor Carlos Manuel Miyares Cao, favoreció el desarrollo de las Ciencias Médicas en Cuba. Institución de prestigio, que arribó este 2021 a su Aniversario 35, y que ha obtenido un gran impacto en la salud y calidad de vida de personas con enfermedades dermatológicas como vitiligo, psoriasis y alopecia. Objetivo: Conocedores de la importancia de salvaguardar los hitos históricos como elementos imprescindibles en la trayectoria científico-social de una institución, nos propusimos exponer los componentes fundamentales que conforman este Centro de Histoterapia Placentaria e incentivar a las nuevas generaciones para continuar la labor investigativa que realiza este y la necesidad de preservar su historia. Material y Métodos: Se realizó una investigación histórico-bibliográfica de los documentos compilados que se conservan en la Biblioteca del Centro para poder fundamentar este artículo. Desarrollo: Se incluyen los aspectos esenciales que avalan la historia del Centro y la imbricación científico-social-humana en este del Dr. Carlos Manuel Miyares Cao. Conclusiones: Históricamente ofrecer toda la trayectoria de este Centro de Histoterapia Placentaria y su significación e importancia para la Ciencia Cubana, así como transmitir a especialistas, médicos y, en general, trabajadores de la salud, su destacada labor en la recuperación de graves enfermedades que aquejan a la población mundial(AU)

Introduction: As a result of the international repercussion of a new Cuban method for treating vitiligo with a drug obtained from human placenta, discovered by Dr. Carlos Manuel Miyares Cao, the Placental Histotherapy Center was founded on April 25, 1986 to support the development of Medical Sciences in Cuba. This prestigious institution, which arrived to its 35th Anniversary this year, has made a significant impact on the health and quality of life of people with dermatological diseases such as vitiligo, psoriasis and alopecia. Objective: Knowing the importance of safeguarding historical milestones as essential elements in the scientific and social trajectory of an institution, we intend to present the fundamental components that make up the Placental Histotherapy Center as well as to encourage new generations to continue the research work carried out in this center and the need to preserve its history. Material and Methods: A historical and bibliographical investigation of the documents preserved in the Library of the Center was carried out to base this article. Development: The essential aspects that support the history of the Center as well as the scientific, social and human involvement of Dr. Carlos Manuel Miyares Cao in this process are included. Conclusions: Our objective is to offer the entire trajectory of the Placental Histotherapy Center and its significance and importance for Cuban Science from a historical perspective as well as to inform specialists, doctors, and health workers in general about its outstanding work related to the recovery from serious diseases that afflict the world's population(AU)

Doctor Carlos Manuel Miyares Cao, paradigma de médico / Dr. Carlos Manuel Miyares Cao, an example of an outstanding doctor

José Martí sentenció: "Saberse sacrificar es el precio del éxito durable en todo", y con grandes sacrificios y éxitos en su vida laboral se resume la obra del Dr. Carlos Manuel Miyares Cao, un médico excepcional que supo vincular sus responsabilidades administrativas con la investigación y desarrollo, y la asistencia médica. Incansable luchador por los avances de la Medicina, gestor de la Escuela Cubana de Farmacología, representa un gran ejemplo para los médicos cubanos y de Latinoamérica. Durante su vida estudiantil, colaboró de forma destacada en las actividades que se desarrollaban en la época, siendo fundador de las milicias revolucionarias. Miyares Cao fue uno de los estudiantes de Medicina, fundador integrante de la Milicia Universitaria José Antonio Echeverría, quien con la simbólica camisa rojo vino, pantalón gris y boina negra, desfilaría el 27 de noviembre de 1959 desde la Universidad hasta la explanada de La Punta para rendir tributo a los 8 estudiantes de Medicina, y al decir de él, uno de sus más fraternales compañeros de estudios: ;lo recuerdo muy claro, alto, que por su estatura iba entre las filas finales, con su rifle y marchando con marcada disciplina, tal cual fue en su vida", con sus palabras reflejó los preceptos conceptuales que connotaron su existencia". El Dr. Miyares fue nombrado entre los primeros Instructores no graduados en la cátedra de Farmacología de la Facultad de Medicina de la Universidad de La Habana, tras la renuncia de los profesores universitarios. Asimismo, fundador de la AJR (Asociación Jóvenes Rebeldes) y Unión de Jóvenes Comunistas (UJC universitaria). Tuvo el privilegio de ser de los primeros egresados de la Revolución y su graduación, presidida, en el oriental Pico Turquino, por Fidel Castro, en 1965(AU)

José Martí said: "Knowing how to sacrifice is the price of lasting success for everything". The working life of Dr. Carlos Manuel Miyares Cao is summed up in great sacrifice and success. He was an outstanding doctor who knew how to link his administrative responsibilities to research and development and medical care. As a tireless fighter for the advances of medicine, he was the founder of the Cuban School of Pharmacology and a notable example for Cuban and Latin American doctors. During his student life, he collaborated with important activities that took place at his time, being founder of the revolutionary militias. During his medical studies, he was a founder member of the University Militias "José Antonio Echeverría". Wearing the symbolic red wine shirt, gray pants and black beret, he paraded on November 27, 1959 from the university to the Punta esplanade to pay tribute to the 8 medical students. One of his most fraternal fellow students says, "... I remember him very clearly; he was tall and because of his height he was among the ranks of the final lines; with his rifle he used to march with the discipline that characterized him during all his life." With his words, he illustrated the principles and convictions that marked his existence. After the resignation of university professors, Dr. Miyares was appointed among the first undergraduate Pharmacy instructors at the Department of Pharmacology of the School of Medicine of the University of Havana. He was also the founder of the AJR (Association of Young Rebels) and the UJC (Union of Young Communists) in the university. He had the privilege to be one of the first graduates after de triumph of the Revolution. His graduation, which was held at Pico Turquino in eastern Cuba, was presided by Fidel Castro in 1965(AU)

Copolymacrolactones Grafted with l-Glutamic Acid: Synthesis, Structure, and Nanocarrier Properties.

The enzymatic ring-opening copolymerization (eROP) of globalide (Gl) and pentadecalactone (PDL) was performed in solution from mixtures of the two macrolactones at ratios covering the whole range of comonomeric compositions. The resulting P(Glx-r-PDLy) random copolyesters were aminofunctionalized by thiol-ene reaction with aminoethanethiol. ROP of γ-benzyl-l-glutamate N-carboxyanhydride initiated by P(Glx-r-PDLy)-NH2 provided neutral poly(γ-benzyl-l-glutamate)-grafted copolyesters, which were converted by hydrolysis into negatively charged hybrid copolymers. Both water-soluble and nonsoluble copolymers were produced depending on copolymer charge and their grafting degree, and their capacity for self-assembling in nano-objects were comparatively examined. The emulsion solvent-evaporation technique applied to the chloroform-soluble copolymers grafted with benzyl glutamate rendered well-delineated spherical nanoparticles with an average diameter of 200-300 nm. Conversely, micellar solutions in water were produced from copolyesters bearing grafted chains composed of at least 10 units of glutamic acid in the free form. The copolymer micelles were shown to be able to load doxorubicin (DOX) efficiently through electrostatic interactions and also to release the drug at a rate that was markedly pH dependent.

Computing Pressure-Deformation Maps for Braided Continuum Robots.

This paper presents a method for computing sensorimotor maps of braided continuum robots driven by pneumatic actuators. The method automatically creates a lattice-like representation of the sensorimotor map that preserves the topology of the input space by arranging its nodes into clusters of related data. Deformation trajectories can be simply represented with adjacent nodes whose values smoothly change along the lattice curve; this facilitates the computation of controls and the prediction of deformations in systems with unknown mechanical properties. The proposed model has an adaptive structure that can recalibrate to cope with changes in the mechanism or actuators. An experimental study with a robotic prototype is conducted to validate the proposed method.

Rescue Snorkel Technique in a Giant Ruptured Aortic Aneurysm With Thoracic Endovascular Aortic Repair Failure.

A 67-year-old man was sent to our center because of progressively worsening chest pain. A giant ruptured thoracic aortic aneurysm was documented. We performed a successfully rescue snorkel technique for thoracic endovascular aortic repair failure because of type IA endoleak after the first endoprosthesis implantation. The patient was discharged after 6 weeks. (Level of Difficulty: Advanced.).

Validation of Smart Nanoparticles as Controlled Drug Delivery Systems: Loading and pH-Dependent Release of Pilocarpine.

Micelles are good devices for use as controlled drug delivery systems because they exhibit the ability to protect the encapsulated substance from the routes of degradation until they reach the site of action. The present work assesses loading kinetics of a hydrophobic drug, pilocarpine, in polymeric micellar nanoparticles (NPs) and its pH-dependent release in hydrophilic environments. The trigger pH stimulus, pH 5.5, was the value encountered in damaged tissues in solid tumors. The new nanoparticles were prepared from an amphiphilic block copolymer, [(HEMA19%-DMA31%)-(FMA5%-DEA45%)]. For the present research, three systems were validated, two of them with cross-linked cores and the other without chemical stabilization. A comparison of their loading kinetics and release profiles is discussed, with the support of additional data obtained by scanning electron microscopy and dynamic light scattering. The drug was loaded into the NPs within the first minutes; the load was dependent on the degree of cross-linking. All of the systems experienced a boost in drug release at acidic pH, ranging from 50 to 80% within the first 48 h. NPs with the highest degree (20%) of core cross-linking delivered the highest percentage of drug at fixed times. The studied systems exhibited fine-tuned sustained release features, which may provide a continuous delivery of the drug at specific acidic locations, thereby diminishing side effects and increasing therapeutic rates. Hence, the studied NPs proved to behave as smart controlled drug delivery systems capable of responding to changes in pH.

Aplicación del Responsive Web Design en la creación e implementación del sitio Web del Centro de Histoterapia Placentaria / Application of Responsive Web Design in the creation and implementation of the website of the Placental Histotherapy Center

La diversidad de dispositivos conectados a Internet ha conllevado en la actualidad a un cambio en la concepción del diseño Web. La navegación, utilizando dispositivos de diferentes resoluciones y tamaños de pantalla, ha modificado de manera radical la experiencia del usuario. El sitio Web del Centro de Histoterapia Placentaria de Cuba creado en el año 2000 y modificado en varias ocasiones, según las tendencias del diseño no está ajeno a esta realidad. El objetivo general de este trabajo es crear e implementar un nuevo diseño del sitio, aplicando la filosofía de Responsive Web Design. Su empleo garantiza la visibilidad del sitio en cualquier dispositivo; ya sea, Smartphone, tableta, computadoras o smart TV. El diseño estuvo basado en el patrón Modelo-Vista-Controlador; en la Vista se concibieron dos interfaces, una para el usuario y otra para el administrador del sitio. El nuevo diseño soluciona el problema de la visibilidad en la gama de dispositivos móviles, permite un mejor posicionamiento del sitio en los buscadores y crea las bases para incorporar nuevos servicios como el Comercio Electrónico(AU)

The diversity of devices connected to the Internet has changed the conception of Web design. The navigation, using devices of different resolutions and screen sizes has radically modified the user experience. The Website of the Placental Histotherapy Center of Cuba, created in 2000 and modified several times according to design trends, is not far of this reality. The general objective of this work is to create and implement a new site design, applying the philosophy of Responsive Web Design, which allows the visibility from devices, such as: Smartphone, Tablet, computers or smart TV. The design was based on the Model-View-Controller pattern; In Vista, two interfaces were conceived, one for the user and another for the site administrator. The new design solves the problem of visibility in the range of mobile devices, allows a better positioning of the site in the search enginesand creates the bases to incorporate new services such as Electronic Commerce(AU)

Caracterización bibliométrica de la comunidad científica especializada en el estudio de la alopecia areata / Bibliometric characterization of the scientific community specialized in the study of alopecia areata

Los dominios del conocimiento están estrechamente relacionados con las comunidades que se integran para su configuración y desarrollo. La bibliometría constituye una de las formas más objetivas para el análisis y caracterización de estas comunidades. El presente estudio caracterizó, a través de la perspectiva bibliométrica, el comportamiento de la comunidad científica especializada en alopecia areata durante el período 2001-2014. Se utilizó el Web of Science como fuente de información. Se empleó una batería de indicadores bibliométricos para determinar la productividad, influencia y rendimiento de los autores, así como para caracterizar sus investigaciones más relevantes. Se determinó la productividad anual, que evidenció durante el período un crecimiento exponencial de la producción científica sobre Alopecia Areata. Se identificaron las 15 revistas más productivas, que generaron alrededor del 50 % del volumen total de artículos. Se identificó el núcleo de autores más visibles del dominio. Se demostró la utilidad del índice H no solo como indicador para determinar el rendimiento científico, sino también como medida para la identificación del liderazgo en dominios del conocimiento científico, especialmente en el campo de las Ciencias Médicas.

Knowledge domains are strongly related to the communities integrated for their configuration and development. Bibliometrics is one of the more objective ways to the analysis and characterization of these communities. The current study characterized the behavior of the scientific community specialized on alopecia areata during the period 2001-2014, through a bibliometric perspective. The Web of Science was used as information source. A battery of bibliometric indicators was used to determine productivity, influence and performance of authors, as well as to characterize their most relevant researches. Annual productivity was determined. An exponential growth of the scientific output on alopecia areata was observed. The fifteen most productive journals were identified, which produced around 50 % of the total amount of articles. The most visible author´s core was identified. The value of H index was demonstrated, not only as indicator to determine scientific performance, but also as a measure to identify leadership in scientific knowledge domains, especially in the field of Medical Sciences.

Non-invasive lung cancer diagnosis by detection of GATA6 and NKX2-1 isoforms in exhaled breath condensate.

Lung cancer (LC) is the leading cause of cancer-related deaths worldwide. Early LC diagnosis is crucial to reduce the high case fatality rate of this disease. In this case-control study, we developed an accurate LC diagnosis test using retrospectively collected formalin-fixed paraffin-embedded (FFPE) human lung tissues and prospectively collected exhaled breath condensates (EBCs). Following international guidelines for diagnostic methods with clinical application, reproducible standard operating procedures (SOP) were established for every step comprising our LC diagnosis method. We analyzed the expression of distinct mRNAs expressed from GATA6 and NKX2-1, key regulators of lung development. The Em/Ad expression ratios of GATA6 and NKX2-1 detected in EBCs were combined using linear kernel support vector machines (SVM) into the LC score, which can be used for LC detection. LC score-based diagnosis achieved a high performance in an independent validation cohort. We propose our method as a non-invasive, accurate, and low-price option to complement the success of computed tomography imaging (CT) and chest X-ray (CXR) for LC diagnosis.

[Hospital-based multicenter study in Spain, Mexico and Cuba on attitudes to living liver donation]. / Estudio multicéntrico hospitalario en España, México y Cuba de actitud hacia la donación de vivo hepática.

INTRODUCTION: Given the lack of a sufficient number of livers available for transplantation, living liver donation (LLD) is being developed in the Spanish-speaking world. To do this, it is essential that health workers in hospitals are in favor of such donation, given that they are a key component in this treatment and that their attitudes influence public opinion. OBJECTIVE: To analyze attitude toward LLD among hospital personnel from healthcare centers in Spain and Latin America. MATERIAL AND METHOD: Ten hospitals were selected from the «International Donor Collaborative Project¼: 3 from Spain, 5 from Mexico and 2 from Cuba. Random sampling stratified by type of service and job category was used. Attitudes to LLD were evaluated through a validated questionnaire on psychosocial aspects. The questionnaire was anonymous and self-administered. Statistical tests consisted of Student's T test, the chi-square test and logistic regression analysis. RESULTS: Of the 2,618 employees surveyed, 85% (n=2,231) were in favor of related LLD; of these, 31% (n=804) were in favor of unrelated LLD. No association was found between the country of the interviewed, personal-social variables or work-related variables. The following factors were associated with a favorable attitude toward related LLD donation: having had personal experience of donation and transplantation (P<.001); being in favor of deceased donation (P<.001); believing that one might need a possible transplant (P<.001); being in favor of living kidney donation (P<.001); being willing to accept a liver from a living donor (P<.001); having discussed the matter of donation and transplantation within the family (P<.001) and with one's partner (P<.001); carrying out pro-social type activities (P<.001); being Catholic (P=.040); believing that one's religion is in favor of donation and transplantation (P<.001); and not being concerned about the possible mutilation of the body after donation (P<.001). CONCLUSIONS: Hospital personnel from Spain and Latin America had a favorable attitude toward LLD, which was associated with factors directly and indirectly related to donation and transplantation, family and religious factors, and attitudes toward the body.

Purity and adulterant analysis of crack seizures in Brazil.

Cocaine represents a serious problem to society. Smoked cocaine is very addictive and it is frequently associated with violence and health issues. Knowledge of the purity and adulterants present in seized cocaine, as well as variations in drug characteristics are useful to identify drug source and estimate health impact. No data are available regarding smoked cocaine composition in most countries, and the smoked form is increasing in the Brazilian market. The purpose of the present study is to contribute to the current knowledge on the status of crack cocaine seized samples on the illicit market by the police of São Paulo. Thus, 404 samples obtained from street seizures conducted by the police were examined. The specimens were macroscopically characterized by color, form, odor, purity, and adulterant type, as well as smoke composition. Samples were screened for cocaine using modified Scott test and thin-layer chromatographic (TLC) technique. Analyses of purity and adulterants were performed with gas chromatography equipped with flame ionization detector (GC-FID). Additionally, smoke composition was analyzed by GC-mass spectrometry (MS), after samples burning. Samples showed different colors and forms, the majority of which is yellow (74.0%) or white (20.0%). Samples free of adulterants represented 76.3% of the total. Mean purity of the analyzed drug was 71.3%. Crack cocaine presented no correlations between macroscopic characteristics and purity. Smoke analysis showed compounds found also in the degradation of diesel and gasoline. Therefore, the drug marketed as crack cocaine in São Paulo has similar characteristics to coca paste. High purity can represent a greater risk of dependency and smoke compounds are possibly worsening drug health impact.

Knowledge of the brain death concept by personnel in Spanish and Latin-American healthcare centers.

BACKGROUND: The knowledge and acceptance of the concept of brain death (BD) among health care personnel is fundamental. OBJECTIVE: To analyze the level of understanding of the BD concept among personnel in Spanish and Latin American healthcare centers and to determine the factors affecting this attitude. MATERIAL AND METHODS: Data from 12 hospitals and 32 primary care centers in 4 countries within the International Collaborative Donor Project were selected (Spain, Mexico, Cuba and Costa Rica (n=4378)). RESULTS: 62% of the personnel (n=2714) understood BD and believed that this was the death of an individual. Of the rest, 30% (n=1333) did not understand it and the remaining 8% (n=331) believed it did not mean the death of a patient. 83% (n=931) of physicians understood BD, compared to 75% (n=895) of nurses, 55% (n=299) of healthcare assistants, 53% (n=108) of non-healthcare university-educated personnel and 36% (n=481) of those without a university education (p<0.001). 68% (n=1084) of Mexicans understood BD compared to 66% (n=134) of Cubans, 58% (n=1411) of Spaniards, and 52% (n=85) (p<0.001) of Costa Ricans. There were significant relationships between knowledge of the concept and the following: type of healthcare center (p<0.001), clinical service (p<0.001), having spoken about organ donation within the family (p<0.001) and one's partner's attitude to the subject (p<0.001). A direct relationship has been found between understanding the concept and attitude toward deceased donation (p<0.001). CONCLUSIONS: The understanding of BD by personnel from healthcare centers was not as good as expected. There were marked differences depending on job category.

Desarrollo de gangrena en paciente inoculado por Pterois volitans (pez león). Presentación de un caso / Development of Gangrene in a Patient Inoculated by Pterois volitans (lionfish). A Case Report

En los últimos años se observa un alza de la incidencia de casos clínicos por picadura de pez león, que en su mayoría evolucionan sin complicaciones. Se presenta a un paciente de 74 años de edad, pescador, que fue picado en alta mar por un pez león (Pterois volitans) en el miembro inferior izquierdo. A partir de ese momento comenzó con dolor intenso en la zona de la lesión y fiebre. Luego de casi 18 horas de exposición al tóxico, fue llevado al Hospital de Caibarién, desde donde se solicitó información toxicológica y conducta a seguir al Centro de Toxicología de Villa Clara. Después de orientar las medidas a tomar, el paciente fue trasladado para el Hospital Provincial en Santa Clara. Luego de tratamiento quirúrgico y de terapia con antibióticos, el paciente comenzó a evolucionar de forma satisfactoria sin presentar más complicaciones hasta su egreso. Existe cierto desconocimiento por parte del personal de salud en cuanto a la conducta a seguir ante un paciente inoculado por esta especie, motivo por el cual se presenta el caso. Mediante la descripción de la evolución de este paciente, el artículo se propone divulgar el potencial toxicológico que representa el pez león.

In recent years there has been an increase in the incidence of clinical cases due to lionfish sting, most of them recover without complications. The case of 74 year-old fisherman who was stung on the high seas by a lionfish (Pterois volitans) in the left lower limb is presented. From that moment on he began suffering a severe pain in the wound site and fever. Nearly 18 hours following exposure to the poison, he was taken to the Hospital of Caibarién, where toxicological information and procedures to follow were asked to the Toxicology Center of Villa Clara. After instruction of actions to take, the patient was transferred to the Provincial Hospital in Santa Clara. Surgical treatment and antibiotic therapy led to the patient’s uneventful recovery until his discharge. There is some lack of knowledge among health personnel regarding the steps to be followed with a patient inoculated by this species, which is why this case is presented, since patient outcomes will largely depend on how fast they act.

Spanish-Latin American multicenter study of attitudes toward organ donation among personnel from hospital healthcare centers.

INTRODUCTION: Hospital personnel are a group which has an influence on the opinion of the rest of the population about healthcare matters. Any unfavorable attitude of this group would be an obstacle to an increase in organ donation. OBJECTIVE: To analyze the attitude of hospital workers toward the donation of one's own organs in Spanish and Latin American hospitals and to determine the factors affecting this attitude. MATERIAL AND METHOD: Eleven hospitals from the "International Collaborative Donor Project" were selected, 3 in Spain, 5 in Mexico, 2 in Cuba and one in Costa Rica. A random sample was stratified by the type of service and job category. Attitude toward donation and transplantation was assessed using a validated survey. The questionnaire was completed anonymously and was self-administered. STATISTICAL ANALYSIS: Student's t-test, the χ2 test and logistic regression analysis. RESULTS: Of the 2,785 workers surveyed, 822 were from Spain, 1,595 from Mexico, 202 from Cuba and 166 from Costa Rica and 79% (n=2,191) were in favor of deceased organ donation. According to country, 94% (n=189) of Cubans were in favor, compared to 82% (n=1,313) of the Mexicans, 73% (n=121) of the Costa Ricans and 69% (n=568) of the Spanish (P<.001). In the multivariate analysis, the following variables had the most specific weight: 1) originating from Cuba (odds ratio=8.196; P<.001); 2) being a physician (OR= 2.544; P<.001); 3) performing a job related to transplantation (OR = 1.610; P=.005); 4) having discussed the subject of donation and transplantation within the family (OR= 3.690; P<.001); 5) having a partner with a favorable attitude toward donation and transplantation (OR= 3.289; P<.001); 6) a respondent's belief that his or her religion is in favor of donation and transplantation (OR= 3.021; P=.001); 7) not being concerned about the possible mutilation of the body after donation (OR= 2.994; P<.001); 8) the preference for other options apart from burial for treating the body after death (OR= 2.770; P<.001); and 9) acceptance of carrying out an autopsy if one were needed (OR= 2.808; P<.001). CONCLUSIONS: Hospital personnel in Spanish and Latin American healthcare centers had a favorable attitude toward donation, although 21% of respondents were not in favor of donating. This attitude was more favorable among Latin American workers and was very much conditioned by job-related and psychosocial factors.

The attitude toward living kidney donation among personnel from units related to donation and transplantation in Spain, Mexico and Cuba.

BACKGROUND: Living kidney donation (LKD) is becoming increasingly necessary as a treatment option for reducing the deficit in transplant organs. Hospital personnel in services related to donation and transplantation play a key role in promoting this kind of donation. OBJECTIVE: To analyze the attitude toward LKD among hospital workers in services related to donation and transplantation in Spain and Latin America. METHODS: Eight hospitals in the "International Collaborative Donor Project" were selected (Spain-Mexico-Cuba). A random sample was taken which was stratified according to the type of service and job category, in transplant-related services. RESULTS: Of the 878 respondents, 90% were in favor of related LKD, and 28% were in favor if the LKD was not related. Attitude was more favorable among Latin Americans workers compared to the Spanish (p=0.014). Other factors associated to attitude included: age (p=0.004); an attitude in favor of deceased donation and living liver donation (p<0.001); and acceptance of a kidney from a donor (p<0.001). CONCLUSIONS: The attitude toward related LKD was very favorable among hospital personnel in units related to the donation and transplantation process in Spain and Latin America, which means that they could contribute to its promotion particularly at the current time when living kidney donation needs to be expanded.